We present a case of 50 year old male patient with coexistence of Pneumothorax and Chilaiditi sign.Chilaiditi sign is an incidental radiographic finding of a usually asymptomatic condition in which a part of intestine...We present a case of 50 year old male patient with coexistence of Pneumothorax and Chilaiditi sign.Chilaiditi sign is an incidental radiographic finding of a usually asymptomatic condition in which a part of intestine is located between the liver and diaphragm;however,the term"Chilaiditi syndrome"is used for symptomatic hepatodiaphragmatic interposition.The patient had no symptoms of abdominal pain,constipation,diarrhea,or emesis.Incidentally,Chilaiditi sign was diagnosed on chest radiography.Pneumothorax is defined as air in the pleural space.Pneumothoraces are classified as spontaneous or traumatic.Spontaneous pneumothorax is labelled as primary when no underlying lung disease is present,or secondary,when it is associated with pre-existing lung disease.Our case is the rare in the literature indicating the coexistence of Chilaiditi sign and pneumothorax.展开更多
Purpose: Chilaiditi’s syndrome is the hepatodiaphragmatic interposition of the colon. Its diagnosis poses challenge to clinicians, and misdiagnosis may results in unnecessary exploratory laparotomy being performed. T...Purpose: Chilaiditi’s syndrome is the hepatodiaphragmatic interposition of the colon. Its diagnosis poses challenge to clinicians, and misdiagnosis may results in unnecessary exploratory laparotomy being performed. The purpose of this study was to report our experience in diagnosis, management, and clinical outcome of patients with Chilaiditi’s syndrome. Methods: Nine cases of Chilaiditi’s syndrome from April 2005 to January 2007 at one institute. The clinical characteristic, imaging studies, management and results were recorded. Results: Six patients presented with abdominal distension (2 patients with abdominal pain;5 patients with constipation), while Chilaiditi’s syndrome in the other three patients were found incidentally. All patients underwent chest X-ray. The Chilaiditi’s sign could be detected in seven patients;while the other two patients presented with no specific finding. Abdominal plain films (KUB) were all reviewed. Most of the patients (n = 8) showed ileus and one patient showed no specific finding. Impacted stool could be detected in five of nine patients. Abdominal ultrasound was performed in two patients. Gallstones were detected in one of them while the other revealed no specific finding. Six of nine patients underwent CT of abdomen, one of them revealed bowel loops in bilateral subphrenic space. One patient underwent subtotal colectomy because of volvulus of sigmoid colon. Five patients were treated with laxative and enema successfully and had been remained asymptomaticcally for a mean follow-up of 6.6 months. The other three cases were under observation. Conclusions: Presence of haustral folds of bowel loops may help us in diagnosing Chilaiditi’s syndrome. The left lateral decubitus abdominal plain film can also help to differentiate between pneumoperitoneum to Chilaiditi’s sign. Most of the cases with Chilaiditi’s syndrome can be resolved with conservative treatment and surgical intervention was reserved for patients with sign of systemic toxicity or peritonitis.展开更多
Symptomatic hepato-diaphragmatic interposition of a bowel loop or Chilaiditi's syndrome is a peculiar anatomical condition most often found by chance. Its described symptoms range from intermittent, mild abdominal...Symptomatic hepato-diaphragmatic interposition of a bowel loop or Chilaiditi's syndrome is a peculiar anatomical condition most often found by chance. Its described symptoms range from intermittent, mild abdominal pain and dyspepsia to acute intestinal obstruction. We report a case of hepato-diaphragmatic migration of the hepatic flexure of the colon associated to an unusual, heretofore unreported, angina-like pain exclusively evoked by the left lateral decubitus. To maximize the chance of observing anatomical changes in different postures, computed tomography of the chest and abdomen was performed after air insufflation into the colon. While frank herniation into the chest was excluded, the scan showed that the hepatic flexure-with the interposition of the diaphragm-came in contact with the right side of the heart in the left lateral, but not in the supine, decubitus. This finding was reproduced by echocardiography which also showed virtually unaltered hemodynamics after the change of posture. ECG, left and right ventricular global and regional function as well as cardiac injury markers also remained unchanged during the maneuver, indicating that the pain evoked by the latter was unlikely due to myocardial ischemia. This case suggests that Chilaiditi's syndrome should be included among the possible, although rare,causes of unexplained angina-like symptoms.展开更多
文摘We present a case of 50 year old male patient with coexistence of Pneumothorax and Chilaiditi sign.Chilaiditi sign is an incidental radiographic finding of a usually asymptomatic condition in which a part of intestine is located between the liver and diaphragm;however,the term"Chilaiditi syndrome"is used for symptomatic hepatodiaphragmatic interposition.The patient had no symptoms of abdominal pain,constipation,diarrhea,or emesis.Incidentally,Chilaiditi sign was diagnosed on chest radiography.Pneumothorax is defined as air in the pleural space.Pneumothoraces are classified as spontaneous or traumatic.Spontaneous pneumothorax is labelled as primary when no underlying lung disease is present,or secondary,when it is associated with pre-existing lung disease.Our case is the rare in the literature indicating the coexistence of Chilaiditi sign and pneumothorax.
文摘Purpose: Chilaiditi’s syndrome is the hepatodiaphragmatic interposition of the colon. Its diagnosis poses challenge to clinicians, and misdiagnosis may results in unnecessary exploratory laparotomy being performed. The purpose of this study was to report our experience in diagnosis, management, and clinical outcome of patients with Chilaiditi’s syndrome. Methods: Nine cases of Chilaiditi’s syndrome from April 2005 to January 2007 at one institute. The clinical characteristic, imaging studies, management and results were recorded. Results: Six patients presented with abdominal distension (2 patients with abdominal pain;5 patients with constipation), while Chilaiditi’s syndrome in the other three patients were found incidentally. All patients underwent chest X-ray. The Chilaiditi’s sign could be detected in seven patients;while the other two patients presented with no specific finding. Abdominal plain films (KUB) were all reviewed. Most of the patients (n = 8) showed ileus and one patient showed no specific finding. Impacted stool could be detected in five of nine patients. Abdominal ultrasound was performed in two patients. Gallstones were detected in one of them while the other revealed no specific finding. Six of nine patients underwent CT of abdomen, one of them revealed bowel loops in bilateral subphrenic space. One patient underwent subtotal colectomy because of volvulus of sigmoid colon. Five patients were treated with laxative and enema successfully and had been remained asymptomaticcally for a mean follow-up of 6.6 months. The other three cases were under observation. Conclusions: Presence of haustral folds of bowel loops may help us in diagnosing Chilaiditi’s syndrome. The left lateral decubitus abdominal plain film can also help to differentiate between pneumoperitoneum to Chilaiditi’s sign. Most of the cases with Chilaiditi’s syndrome can be resolved with conservative treatment and surgical intervention was reserved for patients with sign of systemic toxicity or peritonitis.
文摘Symptomatic hepato-diaphragmatic interposition of a bowel loop or Chilaiditi's syndrome is a peculiar anatomical condition most often found by chance. Its described symptoms range from intermittent, mild abdominal pain and dyspepsia to acute intestinal obstruction. We report a case of hepato-diaphragmatic migration of the hepatic flexure of the colon associated to an unusual, heretofore unreported, angina-like pain exclusively evoked by the left lateral decubitus. To maximize the chance of observing anatomical changes in different postures, computed tomography of the chest and abdomen was performed after air insufflation into the colon. While frank herniation into the chest was excluded, the scan showed that the hepatic flexure-with the interposition of the diaphragm-came in contact with the right side of the heart in the left lateral, but not in the supine, decubitus. This finding was reproduced by echocardiography which also showed virtually unaltered hemodynamics after the change of posture. ECG, left and right ventricular global and regional function as well as cardiac injury markers also remained unchanged during the maneuver, indicating that the pain evoked by the latter was unlikely due to myocardial ischemia. This case suggests that Chilaiditi's syndrome should be included among the possible, although rare,causes of unexplained angina-like symptoms.
